Urata Fuu, Akaishi Takanobu, Uchida Chiaki, Jin Hiroyuki, Nakai Makoto, Kato Masashi, Kawashima Hiroaki, Toyoki Yoshikazu
Dept. of Surgery, Aomori City Hospital.
Gan To Kagaku Ryoho. 2023 Dec;50(13):1792-1794.
All three patients were female, one in her 50s, and the other two in their 60s. The one in her 50s had liver metastasis and the other two had unresectable advanced cholecystic carcinomas with peritoneal dissemination. All three received 8-12 courses of gemcitabine plus CDDP(GC). After GC, all three were deemed to be candidates for R0 resection and underwent resection of two central liver segments. In addition, the second patient required an extrahepatic cholangiectomy; an extended cholecystectomy, plus an extrahepatic cholangiectomy, plus a complete omental resection; and the third needed an extended cholecystectomy, plus an extrahepatic cholangiectomy with a partial transverse colon resection, plus a partial duodenectomy. The pathologic response to chemotherapy was moderate in the patient with liver metastases, mild in the one who underwent the omental resection, and moderate in the patient who had the partial resection of the digestive tract. All three patients continued with postoperative chemotherapy. The patient with liver metastases and the one with the partial gastrointestinal tract resection have survived without recurrence for 52 months and 43 months, respectively, after the initial treatment. The patient with the omental resection has survived 44 months after the initial treatment with recurrent peritoneal dissemination and is continuing chemotherapy as an outpatient. Although further study is needed to accumulate more cases, the results suggest the usefulness of multidisciplinary treatment including conversion surgery in cases such as these.
三名患者均为女性，一名50多岁，另外两名60多岁。50多岁的患者有肝转移，另外两名患有无法切除的晚期胆囊癌并伴有腹膜播散。三名患者均接受了8 - 12个周期的吉西他滨联合顺铂（GC）治疗。GC治疗后，三名患者均被认为是R0切除的候选者，并接受了两个肝中央段的切除。此外，第二名患者需要进行肝外胆管切除术；扩大胆囊切除术，加肝外胆管切除术，加完全大网膜切除术；第三名患者需要扩大胆囊切除术，加肝外胆管切除术并部分横结肠切除，加部分十二指肠切除术。肝转移患者对化疗的病理反应为中度，接受大网膜切除术的患者为轻度，接受消化道部分切除术的患者为中度。三名患者均继续进行术后化疗。肝转移患者和接受消化道部分切除术的患者在初始治疗后分别无复发存活了52个月和43个月。接受大网膜切除术的患者在初始治疗后存活了44个月，出现复发性腹膜播散，目前作为门诊患者继续化疗。尽管需要进一步研究以积累更多病例，但结果表明多学科治疗包括这类病例的转化手术是有用的。
